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DR. STEPHEN J TIDIK M.D. NPI 1053306803


NPI Information

NPI: 1053306803
Provider Name: DR. STEPHEN J TIDIK, M.D.
Classification: Surgery - 208600000X
Entity Type: Individual

PECOS Registration: Yes

Address:
77 CASA ST
SUITE 103
SAN LUIS OBISPO, CA
ZIP 93405
Phone: (805) 544-8993
Get Directions

DR. Stephen J Tidik, M.D. is a surgery in San Luis Obispo, CA. The provider is a general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. DR. Stephen J Tidik, M.D. NPI is 1053306803. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

77 CASA ST
SUITE 103
SAN LUIS OBISPO, CA
ZIP 93405-803
Phone: (805) 544-8993
Fax: (805) 544-0120

The NPI 1053306803 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/19/2005 and was last updated on 6/17/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistG57086CALIFORNIANo
2208600000XSurgeryG57086CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1G57086OTHERCALIFORNIAMEDICAL LICENSE
2330002783MEDICARE PINCALIFORNIA
300G570860MEDICAIDCALIFORNIA
4B58021MEDICARE UPINCALIFORNIA
5WG57086CMEDICARE PINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.